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This is VAERS ID 269209

History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

269209
VAERS Form:
Age:15.0
Gender:Female
Location:Washington
Vaccinated:2006-11-13
Onset:2006-11-13
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) / MERCK & CO. INC. 0954F / - - / IM

Administered by: Other      Purchased by: Unknown
Symptoms: Dizziness, Fatigue, Headache, Pain, Tinnitus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pencillin allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type':

Write-up:Information has been received from a registered nurse at an OB/GYN''''s office concerning a 14 year old female with penicillin allergy who on 13 Nov 2006 was vaccinated intramuscularly in the left deltoid with Gardasil (yeast) (lot #653938/0954F). There was"no concomitant medication. On 13 Nov 2006 the patient experienced pain in the vaccinated arm, headache, dizziness, fatigue, weakness and ringing in the ears. The patient sought treatment from her pediatrician. At the time of this report the patient''''s pai


Changed on 12/8/2009

269209 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Washington
Vaccinated:2006-11-13
Onset:2006-11-13
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HUMAN PAPILLOMAVIRUS RECOMBINANT VACCINE, QUADRIVALENT (GARDASIL) HPV (GARDASIL) / MERCK & CO. INC. 0954F / - - / IM

Administered by: Other      Purchased by: Unknown Other
Symptoms: Dizziness, Fatigue, Headache, Pain, Tinnitus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pencillin allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': (blank) WAES0611USA05100

Write-up:Information has been received from a registered nurse at an OB/GYN''''s OB/GYN''s office concerning a 14 year old female with penicillin allergy who on 13 Nov 2006 was vaccinated intramuscularly in the left deltoid with Gardasil (yeast) (lot #653938/0954F). There was"no was no concomitant medication. On 13 Nov 2006 the patient experienced pain in the vaccinated arm, headache, dizziness, fatigue, weakness and ringing in the ears. The patient sought treatment from her pediatrician. At the time of this report the patient''''s pai patient''s pain in the arm, headache, dizziness, fatigue, weakness and ringing in the ears persisted. Additional information has been requested.


Changed on 5/14/2017

269209 Before After
VAERS Form:
Age:15.0
Gender:Female
Location:Washington
Vaccinated:2006-11-13
Onset:2006-11-13
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / - - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Pain, Tinnitus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pencillin allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA05100

Write-up:Information has been received from a registered nurse at an OB/GYN''s office concerning a 14 year old female with penicillin allergy who on 13 Nov 2006 was vaccinated intramuscularly in the left deltoid with Gardasil (yeast) (lot #653938/0954F). There was no concomitant medication. On 13 Nov 2006 the patient experienced pain in the vaccinated arm, headache, dizziness, fatigue, weakness and ringing in the ears. The patient sought treatment from her pediatrician. At the time of this report the patient''s pain in the arm, headache, dizziness, fatigue, weakness and ringing in the ears persisted. Additional information has been requested.


Changed on 9/14/2017

269209 Before After
VAERS Form:(blank) 1
Age:15.0
Gender:Female
Location:Washington
Vaccinated:2006-11-13
Onset:2006-11-13
Submitted:2006-12-14
Entered:2006-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
HPV4: HPV (GARDASIL) / MERCK & CO. INC. 0954F / - UNK - / IM

Administered by: Other      Purchased by: Other
Symptoms: Asthenia, Dizziness, Fatigue, Headache, Pain, Tinnitus

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit? (V2.0) No
Hospitalized? No
Previous Vaccinations:
Other Medications: NONE
Current Illness:
Preexisting Conditions: Pencillin allergy
Allergies:
Diagnostic Lab Data: NONE
CDC 'Split Type': WAES0611USA05100

Write-up:Information has been received from a registered nurse at an OB/GYN''s office concerning a 14 year old female with penicillin allergy who on 13 Nov 2006 was vaccinated intramuscularly in the left deltoid with Gardasil (yeast) (lot #653938/0954F). There was no concomitant medication. On 13 Nov 2006 the patient experienced pain in the vaccinated arm, headache, dizziness, fatigue, weakness and ringing in the ears. The patient sought treatment from her pediatrician. At the time of this report the patient''s pain in the arm, headache, dizziness, fatigue, weakness and ringing in the ears persisted. Additional information has been requested.


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